What a difference a year makes! Last year, a majority of readers were in favor of the Affordable Care Act. This year, it's a minority.

What a difference a year makes! Last year, a majority of readers were in favor of the Affordable Care Act (ACA). This year, it's a minority.

In June of 2012, MedPage Today asked readers if the Supreme Court did the right thing when it ruled the ACA, in particular its individual mandate, did not violate the Constitution, but effectively left the decision to expand Medicaid up to each state.

As part of our anniversary coverage of the Supreme Court's vote, we asked the same question again.

The vote tallies are like peering through Alice's looking glass: nearly an eerie mirror image of each other:

2012 -- 59% Yes, 41% No

2013 -- 40% Yes, 60% No

What happened?

A Step in the Right Direction for Some

In 2012, readers who were in favor of the ACA expressed an exhausted gratitude that it was a step in the right direction. It may not be perfect, they said, but it's a start to fix a system that definitely needs fixing.

They said insuring everyone is the right thing to do. They were full of compassion for those less fortunate, but they also wondered if the ACA was workable.

In 2012, those who were not in favor of the court's decision expressed themselves in many different shades of negativity.

Obamacare would ruin the country. Look at how other countries with socialized medicine can't sustain that model. We might need healthcare reform but the ACA is not the answer. It will only enrich insurance and pharmaceutical companies.

The comments from this week's survey from those that are in favor of the ACA reflect a measured, thoughtful attitude.

"Yes, the SCOTUS [Supreme Court of the U.S.] did the right thing. I would have preferred Medicare for all, but that would never have a chance of passing the insurance lobby and conservatives in Congress. So, what we got was as good a compromise as was possible today," said a reader.

Someone else created a bulleted list to explain her support:

Requiring citizens to carry private medical insurance is the antithesis of socialized medicine

The American Medical Association supports the ACA

A tax is a tax is a tax and is constitutional whether or not one chooses to call it a tax

The mandate preserves capitalism while addressing a very real, long-term and class-pervasive healthcare crisis. Without the mandate, the only alternative IS socialized medicine

A few readers acknowledged they voted "No" only because "we have yet to learn exactly what is in the Act."

Others in agreement with most of the court's decision would have preferred a ruling in favor of the Medicaid expansion.

One reader admitted to being ashamed that the U.S. is the only "developed nation in which individuals die because they cannot afford medical care."

He went on to say, "True American charity was demonstrated at the Republican debate in Texas. When a question was asked about a cancer patient without health insurance, the audience screamed, 'Let him die.'"

This comment from a supporter of the ACA might give a hint about the tone of the comments from those who did not favor the Supreme Court's decision.

"Oh, yawn," he said. "The laundry list of Tea Party platitudes sounds so self-centered."

He reminded readers that their "precious freedom was handed over to corporations and 'the investor class' some time ago."

Naysayers See ACA as Harmful

Nevertheless, the naysayers voiced their strong opposition.

"This so-called Affordable Care Act is and should be called the Unaffordable Care Act. It is nothing more than socialized medicine, with the government now in control of one-sixth of the U.S. economy."

"Remember 'Do No Harm'? Remember subscribing to that? The ACA does harm. Irreparable, fatal harm, to our government, to our finances and financial institutions, to all insurance companies (they will be driven out of business when the government becomes the one-payer system, and tens of thousands of people will be thrown out of work), to research facilities, to pharmaceutical companies, to our hospitals and physicians, and to every patient in America, and to our country," voiced a reader.

Here's a comment you wouldn't have seen last year: "With the government now tapping phone lines, looking in on emails, and checking on your so-called healthcare to make sure you obtain healthcare or pay a fine through the IRS, it is nothing more than tyranny or totalitarianism."

"Just another opportunity to take from the many to give to the few," was a sentiment reflected by many comments.

Several readers noted that Obama had a chance to create meaningful healthcare reform but missed it. Here's one of those comments.

"He could have put everyone on a health savings account with a high deductible and had employers fund the difference with the money unspent coming back to the employee. This would have fixed the problem, as free market principles like supply and demand would have ruled the day. The elephant called healthcare would have been put on a serious diet."

Several readers were frustrated at how the White House argued that the ACA's penalty for not having insurance as not being the same as a tax, and then Supreme Court Chief Justice John Roberts declared it legal on the basis that it was a tax.

This reader reminded others where the bar is set in terms of the government running businesses.

"If you like the way that the government has run Amtrak and the U.S. Post Office, then you will love the way the U.S. Healthcare System will be run by the IRS, HHS, and other panels, boards, and committees that will be set up by the ACA."

And, of course, there generally are a few comments that hint of a conspiracy.

"I think the Supreme Court decision might have been manipulated in the last few weeks leading up to it. Justice Roberts was clearly leaning in one direction then fairly suddenly changed his mind. Was he bribed or blackmailed? He may have a remote skeleton in his closet, or a friend or family member's closet. With the NSA's data mining, all skeletons will be revealed, and skeletons can be very useful for governments who are inclined to use such techniques."

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